Jeff Sadow: Candidates weigh in on elderly services

Taking their campaign statements at face value, most of Louisiana’s gubernatorial candidates seem set on creating more expensive and less effective service delivery regarding some of Louisiana’s most vulnerable residents.

During a recent forum, Public Service Commissioner Scott Angelle, Lt. Gov. Jay Dardenne and state Rep. John Bel Edwards fielded questions about having clients in state programs for the elderly and disabled join other Medicaid recipients in a managed-care regime and whether the state should create a cabinet-level department focusing on the elderly; Sen. David Vitter was absent. Many of the answers boded ill for providing quality service and saving taxpayer dollars.

For years, the Department of Health and Hospitals has moved regular Medicaid clients away from the inefficient fee-for-service model of care, leaving only those receiving community-based and institutional services still part of the old model. The transit has saved hundreds of millions of dollars, although the Louisiana Legislative Auditor has recommended more stringent tracking methods to accurately measure savings. The complexity and high costs of serving many of these remaining clients means savings in this area of service also could be great.

This is particularly true in that the change likely will reduce numbers in high-cost nursing homes. Louisiana has, among the states, one of the highest proportions of the long-term disabled in nursing homes despite having one of the lowest institutional occupancy rates. The plan envisions reducing this proportion by providing incentives to pursue less expensive community-based solutions, leading nursing homes — which already receive more than $15 million a year in state payments for empty beds and have seen reimbursement rates rise about 40 percent in the 2012-16 term — to fight to be excluded from the plan.

At the forum, Angelle expressed doubts about the whole idea, while Edwards remained noncommittal on the issue, saying the state needed to “work this out” as if no plan existed. Only Dardenne sensibly called for moving forward the current plan, which DHH suspended to await a new governor, and he included integrating nursing homes placements into it.

Dardenne also provided the least odious answer to an inquiry about creating a Department of Elderly Affairs. A few special interests, particularly the state’s Councils on Aging, have provoked a turf war over the Jindal administration’s reasonable idea to consolidate elderly services into DHH. Their opposition has prevented the amalgamation, dividing programs for the elderly between DHH and the Governor’s Office of Elderly Affairs.

A Legislative Auditor’s report last year recommended altering the highly decentralized system, which funnels care dollars through both different state agencies and dozens of Councils on Aging. This creates too much bureaucracy — and, in some cases, duplicative services — as opposed to the more compact models used in most states. But to centralize in a Department of Elderly Affairs, which few states have, only would create a different fragmentation. That would thwart the unified administration of service delivery, including that for seniors as envisioned in the comprehensive managed care plan.

Unfortunately, both Angelle and Edwards said they supported the separate department, not mentioning which other department they would disband as constitutionally required. Dardenne suggested folding elderly affairs into the existing Department of Veterans Affairs, yet that imperfect fit would encourage lack of coordination within the continuum of care.

None of this is best practice. Angelle, Edwards and Vitter should join Dardenne in signaling support of Louisiana’s first-in-the-nation transition of all Medicaid clients into managed care. All four should endorse placing all elderly affairs programs under DHH. Both moves would help their clients and lower taxpayers’ costs.

Jeff Sadow is an associate professor of political science at LSU in Shreveport, where he teaches Louisiana politics. He is author of a blog about Louisiana politics (www.between-lines.com) and, when the Louisiana Legislature is in session, another about legislation (www.laleglog.com). His views do not necessarily express those of his employer.